Allergist Interview: Dr. Houshang Farhadian on Non-Allergic Rhinitis
This month, we interviewed Dr. Houshang Farhadian of Valencia Allergy and Asthma Center in California. He spoke with us about non-allergic rhinitis (which is often treated the same way as allergic rhinitis in terms of symptom control) and about how he loves being the one to "make the difference" for an allergy patient. Coincidentally, Dr. Farhadian mentioned FAHF-2, the topic of our feature article this month, as an exciting future allergy treatment option. We definitely will keep following the progress of this exciting prospect.
Please tell me a little bit about yourself and your history as an allergist.
"After graduation from medical school, I spent four years in residency in pediatrics, followed by two and half years of sub-specialty allergy training. I have been practicing for the past thirty years. One of the requirements of training in allergy was being certified in either pediatrics or internal medicine, so I chose pediatrics. However, the sub-specialty of allergy provided training for both pediatric patients and adults.
"I became interested in the field of allergy and immunology because allergies are an unusual reaction in that people with allergies have a reaction from being exposed to something that doesn't affect others. It's challenging and rewarding to find out the cause of a person's allergy, and then hopefully be able to cure it."
How big is your practice? Is there a particular type of allergy or treatment your practice specializes in?
"We have two allergy offices, and I work with another allergist. In each office, we see about thirty patients a day, which includes a couple of new patients, about eight to ten follow-ups, and the rest are mainly here to see us for allergy shots. Our office is a very friendly environment, and my staff are very kind and understanding. My patients feel very comfortable here."
What do you love about your job?
"I love my job because I make the difference. Patients who have been going around and around from one doctor to another and still don't know what their problem is come to me. I spend an hour with them the first time they come, trying to discover the cause or causes of their symptoms. During this consultation, I ask questions that guide me to a diagnosis and the root cause of the problem. This is like detective work.
"Then we do tests and 80 to 90 percent of the time, we confirm the cause and then treat patients accordingly. We like to provide patients with immediate relief, but we also start treating patients with the goal of long term relief.
"We don't do miracles, but when we have patients who can wait a little bit for long term relief and do allergy shots, we can provide them with immunity. Usually, within four to six months, patients who undergo allergy shot therapy achieve immunity, and they don't need to use as much or any medication at all.
"It's very exciting for us to achieve a better quality of life for 80 to 90 percent of our patients, who previously experienced constant problems with runny noses, wheezing, congestion, and other allergy symptoms.
"If you sit in our waiting room and ask patients who have been on my treatment how they are doing, almost all of them will tell you how happy they are with both the treatment and results."
If you could suggest one thing for your patients what would it be?
"The number one piece of advice I would give my patients is practicing environmental control: cleaning the house, getting rid of the dust, pet dander, and other allergens. Secondly, I would recommend some relief with medications. Thirdly, I would suggest they undergo allergy tests and then I would offer treatment for the cause of their allergy problems.
"Interestingly, many of my patients who think they have allergies don't have them. Often, their problem is non-allergic rhinitis, of which there are several kinds. Some patients have very sensitive nerve ends in their nose, and when they inhale smoke, perfumes, or cold air, they suffer from allergy-like symptoms. Others experience a runny nose from eating. Pregnancy also often causes non-allergic rhinitis because of estrogen level changes."
What is your favorite allergy relief product?
"We mostly use nasal sprays. Steroid nasal sprays are very effective for nasal allergies, and recently we've started using some nose sprays that aren't steroids but are still quite effective and have minimal side effects. We also suggest using oral antihistamines to alleviate allergy episodes when they come.
"Sometimes allergy symptoms are associated with non-allergic symptoms; nevertheless, both symptoms together are part of the problem. For example, when allergic individuals are exposed to smoke, dust, pollution, or cold air, allergies get worse. This is called combined allergic rhinitis, and it is mostly related to inhalant allergy problems."
Where do you see allergy treatment going in the near future? In the distant future?
"There are a lot of questions now in the field of allergy and immunology that aren't answered yet. But a lot of things are going on in this field, and a lot of incoming research information, fortunately, indicates promising new allergy relief and treatment options, and maybe even a cure in the coming future. Sublingual immunotherapy (SLIT) is an example.
"In the area of food allergy, researchers are looking into which molecules cause the food allergies, and exploring ways to take allergenic molecules from the foods so allergic individuals can eat them. Another exciting option is the herbal combination FAHF-2, which is now being tested in humans."